Runner's Knee - how to avoid it

1 March 2009 Sunday

12 km - 1h 6min 36

Morning run. My absolute favourite weather: thick mist, quiet, no wind and cool, but not cold. It is St David's Day, but no daffodils yet in the garden, just a clump of snowdrops and a few primroses. Everything is late this year. It's because of that long cold snap last winter, I think.

A friend in England asked me what to do about hurting knees. She has enjoyed running for a long time, but only recently really got the hang of it and started to increase distances and speed. I compose a reply in my head while we slice through the thick sensuos air of the first day of Spring. I thought it'd be a few scribbles, but when I put it on paper it grows into something bigger.

When knees hurt: it's probably the 'runner's knee' a common and nasty problem with cartilage in between the knee cap and big leg bones. One simple test is to walk downstairs - if it is painful then that's what it is. It usually occurs as you reach the 40 miles per week mark.

- if it's not too bad, remember to do warm up, not just cool down stretching. Simple sit down-get up, repeated 10-20 times before the run should help. Stand freely, sit on your heels, get up with arms stretched out.
If you have a circuit training group near you, it's a very good way to learn additional stretching techniques. Besides general fitness exercises circuit training involves a lot of running - all in a structured way. I ran my fastest and most comfortable marathon (3h36min) when I supplemented long runs with two-three times a week circuit training. Training nights were children's swimming/badminton nights, so I didn't feel like I was taking time off family.

- cod liver oil tablets from Boots are really good for bones. Lungs, blood vessels and muscles get used to running much quicker than bones and cartilage. You may feel that your body can take much more when you have run regularly for some time. That's when it is easy to overstretch and then your bones punish you.

- massage with any heat cream (I use Chinese tiger balm, there is a milder golden star vietnamese version). Long soak in hot bath helps. But if there is pain, relieve it by wrapping cold wet towels around them immediately after the run.

- change the way you run or where you run. Try lessening the thumping on your heels - use your legs like horses do. If you look at a horse you will see that there is a 'spare knee' - one, upper, points forwards like ours, and another, lower, points backwards, that's where our heel is. Having a spare knee lets horses (and other four-legged people) to run with an economical light stride. So, try to land on the front of your feet, preferably the outer side of the front part of your foot soles. One marathon friend also suggested to me that putting the points of your feet slightly inwards reduces the strain. Steep rises or downslopes cant affect knees too, try making your circuit flatter.

- check your shoes. You may want to get shoes with more cushioning recommended for long distance running on hard surfaces. Some bigger sports shops have testing threadmills with video cameras and computer analysis - it may be your running style which causes the problem and they may suggest how to change it.

- Also, modern running shoes are only designed to last 500 miles, or based on five 6 mile runs per week = 30 miles/week = 120 miles month = 480 miles in four months. So, shoes should be changed every 5 months. They may look ok, but in fact they will have lost their shock absorption and grip qualities.

- diet - cutting or excluding dairy, especially cheese, and all animal fat may help. Drink lots of water - 8 glasses a day at least. Not having enough water in the body reduces flexibility.

- stop running completely if there is swelling or the pain is sharp. It'll take a couple of weeks to heal. See the doctor, they will have some anti-inflammation drugs or simple paracetamol might help. When we lived in England I had pain in my knees, went to the doctor and she said I had arthritis and won't be able to run any more. I got very depressed, but when we moved to Wales and changed GP, I asked the new doctor to check my knees again. I had them x-rayed and did some funny twists and turns for him - and he declared me clean, no arthritis, go and run. For me it was a moment like the famous resurrection scene in the Bible: Christ tells the dead girl to rise and walk - and she gets up.